Gamma glutamyl transpeptidase in meningitis.

Gamma glutamyl transpeptidase (GGTP) was measured serially in cerebrospinal fluid (CSF) and serum in 23 cases of meningitis (15 pyogenic and 8 tuberculous meningitis) and an equal number of age and sex matched healthy controls, to find out its diagnostic and prognostic significance in meningitis. GGTP activity was significantly elevated (p less than 0.001) in CSF and serum in meningitis as compared to control subjects. Levels were significantly higher in pyogenic as compared to tuberculous meningitis (p less than 0.001) and in CSF than in serum (p less than 0.001). The maximum elevation was seen on the 1st day and thereafter the activity declined in the majority (65.2%) of cases. However, in 3 cases of pyogenic meningitis and 5 cases of tuberculous meningitis, the GGTP activity on subsequent estimation increased serially; all these 8 cases died. It is concluded that CSF GGTP activity is significantly elevated in meningitis and serial rise in its activity is associated with poor prognosis and even fatal outcome.

Autonomic function tests and clinical significance of dysautonomia in chronic liver disease.

Autonomic function in 20 patients with chronic liver diseases was assessed clinically and by various tests like Valsalva ratio, expiratory-inspiratory ratio, postural tachycardia index, atropine ratio, blood pressure response to assumption of erect posture, hand immersion in cold water, and finger wrinkling response to hand immersion in warm water. Eighty per cent of the patients showed some clinical evidence of dysautonomia. While a good correlation between various clinical complaints of dysautonomia and the extent of parasympathetic dysfunction was observed in the individual patient, a significantly greater impairment of sympathetic function tests was observed in oliguric cirrhotics as compared to their non-oliguric counterparts.

Renal dysfunction in enteric fever.

Twenty-five culture positive cases of enteric fever were studied to see the effect of the disease on various kidney functions. The parameters studied were urine examination, blood urea, serum creatinine, serum electrolytes, 24 hours urinary examination (proteins, creatinine, electrolytes), creatinine clearance rate, plain X-ray abdomen, intravenous urogram and circulating immune complexes. Fifteen patients with fever of non-specific origin served as controls. Renal dysfunction was observed in four patients (16%). Repeat tests showed that abnormalities of renal functions, though significant, were short lasting and reversible. Renal biopsy done in three of these cases did not reveal any abnormality.

Lipid profile in enteric fever.

Lipid profile is known to alter in patients with severe sepsis, but few studies regarding the status of lipid levels in enteric fever are available. Twenty patients with enteric fever, belonging to different age groups and both sexes, along with an equal number of matched patients with fever due to non-enteric causes, were studied with regard to alterations in lipid profile. We observed a severe and protracted hypertriglyceridaemia, decrease in HDL-cholesterol levels and increase in LDL-cholesterol levels in patients with enteric fever at the peak of fever. The values returned to normal on recovery and convalescence. This study serves to highlight the complexity of lipid variation during Salmonella typhi infection.

Plasma cortisol levels in enteric fever.

Plasma cortisol levels were estimated in twenty two culture positive cases of enteric fever and in equal number of patients with fever due to non-enteric causes. Patients of typhoid with severe toxaemia and or some complication were found to have lowered mean levels on the day of admission and at the time of defervescence. The levels returned to normal one week later. Patients of typhoid with mild to moderate illness showed elevated levels of plasma cortisol. To conclude cases of typhoid with severe toxaemia and/or complications have lower cortisol levels and may be given supplementary steroids (if no contraindications exist). Since these values return to normal one week after fever subsides, supplementary steroids need not be given for longer than one week of acute illness.

Autonomic function tests in cases of chronic severe anaemia.

Autonomic functions were studied in 30 adult cases of chronic severe anaemia (CSA) and equal number of age and sex matched healthy controls. Blood pressure and heart rate responses to standing, to respiration (expiratory-inspiratory ratio), to Valsalva manoeuvre (Valsalva ratio) and to hand immersion in ice cold water and given 1.8 mg of atropine intravenously were studied. Patients with CSA had significantly high basal pulse rate and low blood pressure as compared to control subjects (p less than 0.001). The expiratory inspiratory ratio was abnormal in 30% of the cases of CSA (p greater than 0.10) valsalva ratio was abnormal in 50% of cases (p less than 0.01) and postural tachycardia was observed in 60% of cases (p less than 0.001). Normal response to hand immersion in ice cold water was observed in 56.6% of cases (p less than 0.001). Atropine resulted in tachycardia in 73.4% of cases of CSA as compared to 86.7% of controls (p less than 0.10). All the cases of CSA showed one or more abnormal response and in 16.6% of cases all responses were abnormal.